Paradoxical effect of smoking following acute myocardial infarction
© Durighel et al; licensee BioMed Central Ltd. 2013
Published: 30 January 2013
Cigarette smoking causes coronary endothelial dysfunction and is a major risk factor for ischemic heart disease and acute ST-elevation myocardial infarction (STEMI) . Prior studies have found that the mortality rate of smokers after AMI may paradoxically be lower than in non-smokers . Epidemiological studies have failed to find a dose-dependent relationship between cardiovascular risk and the number of cigarettes smoked . We used CMR to analyse myocardial infarct size and salvage % in patients following primary percutaneous coronary intervention (PPCI), categorising smokers as never-, ex- and current smokers.
Smoking is associated with smaller infarcts but is not an independent predictor of myocardial salvage. This study further highlights the debate surrounding the "smokers' paradox". Ischemic pre-conditioning, as well as favourable baseline clinical and angiographic characteristics, may be responsible for the more benign prognosis of current smokers . Adaptations in the coronary microcirculation and the subsequent response to ischemia-reperfusion injury may underlie the pathophysiological differences seen in smokers .
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